"You have to call her son immediately."
The voice that rises from room 349 of the intensive care unit of the Estrée clinic, Thursday, November 19, does not bode well.
The central service island, which is usually bustling with activity in this second wave of Covid, is deserted.
All the caregivers are grouped around an intubated patient losing his battle with the virus.
"Pneumothorax", "drain", "adrenaline shot".
In a breath, Doctor Widad Abdi, resuscitator, and caregivers exchange the medical terms of this fierce fight against the coronavirus.
The 74-year-old patient's lungs are in such poor condition that cardiac arrest can occur at any time.
A patient intubated at the Estrée clinic.
On the morning of November 19, the intensive care unit had three intubated patients and four conscious patients with respiratory assistance.
© Mehdi CHEBIL
The patient will die a few minutes before the arrival of his relatives.
He joined the 429 deaths from the Covid recorded during the last 24 hours and the more than 47,000 people officially victims of the epidemic on French territory.
Cold figures, which do not reflect the shock that each death represents for the relatives of the victims.
A personal tragedy which was all the more terrible during the first wave as the remains of a Covid patient was quickly locked in a waterproof cover, without the family being able to meditate or see the body.
This time, relatives can see the deceased one last time.
This Thursday, the patient's son and two relatives are thus authorized to enter room 349.
"This is an important change for the families of the victims, it helps them to mourn," explains Dr Abdi.
A caregiver massages the feet of an intubated patient to prevent pressure sores.
Photo taken at the Estrée clinic on November 19, 2020 © Mehdi CHEBIL
Almost eight months after the first epidemic peak, caregivers have acquired knowledge of the disease and experience of Covid care, which increasingly enables them to avoid such a dramatic outcome.
"The second wave is very different, we have a much higher turnover. In general, patients are better treated and stay here for less time than last spring," says Dr Abdi.
Most patients requiring respiratory assistance (without intubation) now leave after five or seven days, while the delay hovered more between twelve and fifteen days during the first wave.
Better knowledge of Covid-19
The improvement is explained in particular by better care upon admission, as well as more efficient respiratory assistance machines, according to Natacha Julie, resuscitation manager.
"We have additional exams that are done upon admission. For example, we will monitor coagulation from the first blood test, because we know that Covid can cause pulmonary embolism. During the first wave, we focused on the respiratory aspect. Today we can anticipate circulatory problems much better, "says Natacha Julie.
Between the two waves, the Estrée clinic acquired several respiratory assistance machines that allow better oxygenation of patients seriously affected by Covid.
Alain Baissac, 54-year-old plant manager ill with Covid, is on respiratory assistance.
The Optiflow machine is visible under the hands of Natacha Julie, an intensive care manager.
© Mehdi CHEBIL
This machine, the optiflow, heats and humidifies the air, before sending it with a strong and constant flow directly into the patient's nostrils.
For the latter, it means less effort and fatigue to breathe.
An advance that makes it possible to avoid or delay intubation, a very cumbersome last resort procedure, because it involves plunging the patient into a coma to connect his lungs to a ventilator.
"At the start of the first wave, patients arrived at the hospital chain by Smur and they were automatically intubated. Today, we manage better and we intubate less," notes Mylène Leguier, nurse.
The caregiver experienced the first wave as a student at Lariboisière hospital, a large establishment located in the north of Paris.
She joined the Estrée clinic after obtaining her diploma between the two epidemic peaks.
On a personal level, she describes a more difficult first wave to live with, with many more uncertainties and fears, including for her own health.
The plateau of the 2nd wave is reached
The Estrée clinic should cross this second wave without being overwhelmed.
The director of care, Sebastien Carré, compares the first wave to a tsunami, with more than 50% of emergency room visits at the end of March and the beginning of April which fell under the Covid.
The second wave rose less suddenly, with a plateau at around 35% of emergency room visits for coronavirus infections.
A worrying rise, but which reached a plateau at the beginning of November.
“I also have the impression that the profile of Covid patients has changed a bit. People who present with symptoms are often younger than they were last spring, with less severe forms of the disease. vulnerable need to be more careful, ”adds Sébastien Carré.
Between September 1 and November 18, the Estrée clinic recorded 16 deaths from Covid.
A figure to be compared to about sixty victims in the spring, even if the second wave is not over.
The body of a patient who died of Covid is taken to the morgue.
After the mortuary toilet, the remains are placed in a waterproof cover because the coronavirus remains dangerous even after the death of its host.
© Mehdi CHEBIL
In the intensive care unit, the death of this Thursday afternoon put a blow to the morale of the teams.
This was the first Covid death in the service since the start of the second wave.
Most of the previous 16 victims had so many comorbidities - serious, incurable illnesses - that these patients were not placed in intensive care.
The central island of the intensive care unit has since resumed its usual activity.
Caregivers take care of patients on respiratory assistance, while others massage an intubated patient to prevent pressure sores.
“We received a small gift from Madame Noiret!” One of the nurses suddenly exclaims, brandishing a box of oriental pastries.
The 49-year-old patient, released the day before after recovering from Covid, sent this gift as a thank you
"It's nice, but we don't have too much head for that today considering that we lost a patient", explains Doctor Abdi, glancing at the box of sweets on the edge. from the counter, next to a red binder dedicated to deaths.
"We don't really know intubated patients, but by caring for them, it creates attachment. Even if we save ten patients, losing a single one always hurts us."
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